Frozen Section: A Review of Accuracy, Trends and Limitations

Frozen section is a procedure wherein a tissue specimen is snap-frozen, sliced by microtome, and stained immediately for rapid diagnosis of probable malignant lesions. This is a relatively crude procedure compared to paraffin-embedded sections, but is effective because it is rapid and gives the surgeon immediate consultation regarding the malignancy of a tissue. With frozen section there is a risk of misdiagnosing malignancy and under-staging or over-staging patients. As it is subject to many limitations in comparison to the block preparation, this review aims to highlight the important concepts regarding frozen section consultation, current trends, accuracy as well as the limitations of this technique.

The scope of audit committee oversight and financial reporting reliability: Are audit committees overloaded?

Audit committee (AC) responsibilities have been increasing over time, prompting concerns that overloading ACs may impair their effectiveness. Using new measures to capture AC responsibilities based on AC charters, we find that greater AC responsibilities are associated with improved financial statement reliability. Contrary to overload concerns, this association is strongest when ACs have very high levels of responsibilities. Cross-sectional analyses indicate greater AC responsibilities improve financial statement reliability at complex firms, following significant governance lapses, when AC members are capable and experienced, and when ACs also meet often to carry out their oversight duties. Further analysis suggests that our AC responsibility results are driven by duties related to financial reporting while, in stark contrast, allocating responsibilities unrelated to financial reporting to the AC (e.g., risk management) detracts from monitoring effectiveness by decreasing financial statement reliability. The latter is consistent with an overload effect driven by responsibilities that distract the AC from its core financial reporting oversight mandate. Our results inform recent regulatory changes at some exchanges to expand AC oversight

The Implications of IT Environment on the Audit and Financial Reporting Quality

This study explores the impact IT complexity and IT control deficiencies have on the audit and financial reporting. We create and validate a new theory-based measure of IT financial reporting complexity at the client level. Next, we quantify the cost of IT complexity and IT control deficiencies on audit effort. We find that, on average, an increase of one (out of 18) on the client’s complexity score relates to an increase of 6% in IT audit hours. In comparison, the presence of an IT control deficiency relates to a 70% increase in IT audit hours. We further investigate and find that IT specialist experience partially mitigates the cost of IT complexity and IT control deficiencies, in particular, experienced IT managers and senior managers rather than experienced IT partners and directors. Finally, we find that experienced IT specialists are able to mitigate some but not all of the cost of IT complexity on financial reporting reliability. Overall, our results provide some of the first insight into complex IT environments’ costs over financial reporting and highlights the importance of staffing decisions at the manager level

Barrett’s Esophagus: Diagnosis and Management

Barrett’s esophagus is a complication caused by Gastro Esophageal Reflux Disease (GERD). It is a premalignant condition with an increased risk of developing esophageal adenocarcinoma.  The carcinogenic sequence may progress through several steps, from normal esophageal mucosa through Barrett’s esophagus (BE) to esophageal adenocarcinoma (EAC). A recent advent of functional esophageal testing (particularly multichannel intraluminal impedance and pH monitoring) has helped to improve our knowledge about GERD pathophysiology, including its complications and its neoplastic progression. Over the last few decades, the incidence of EAC has continued to rise in Western populations. Thus, major efforts in clinical and research practice are focused on new methods for optimal risk assessment that can stratify BE patients at low or high risk of developing EAC. Furthermore, the area of BE therapeutic management is rapidly evolving. Endoscopic eradication therapies have been shown to be effective, and new therapeutic options for BE and EAC have emerged. The aim of the present review article is to highlight the pathophysiology, diagnosis and the current progress of BE therapy.Moreover, we discuss the new mucosal ablative techniques that can be used in the esophagus have emerged over the past two decades.

The effect of immobilization in the PVA films on the fluorescence and phosphorescence lifetime of indole and its dervatives

This work is devoted to study how immobilization in the PVA films affects the fluorescence and phosphorescence lifetime of indole and its derivatives. The obtained results indicated that immobilization of the studied indoles in the PVA matrix, which leads to the increased microrigidity of the environment around the indole moiety, results in the increase of singlet and triplet excited state lifetime of the studied compounds. Most probably, the enhancement of the rigidity of the environment near the chromophore reduces the rates of the non-radiative deactivation pathways, which leads to the increase of excited state lifetimes of the studied compounds

Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries

Background: Brachial plexus injuries are troubling for the patients socially, economically and emotionally. Elbow joint being a large and vital joint needs to be reanimated so that the patient can carry out his routine work and bring the hand to the mouth. Number of procedures have been defined but latissimus dorsi being a large muscle is the muscle of choice for transfer in cases who present late. Bipolar latissimus dorsi transfers have often been reported but unipolar latissimus dorsi transfer has also been described. Authors have studied the unipolar muscle transfer, it’s surgical technique and results.Methods: In this study 18 patients were studied for demographic data, pre- and post-operative flexion of the elbow and the MRC grade of the corresponding movements. Diagnostic work up in the form of nerve conduction velocity, electromyography and magnetic resonance imaging were carried out and evaluated for their significance in traumatic brachial plexus injuries.Results: In this study 13 patients had avulsion of the C5-6 roots on magnetic resonance imaging. The patients presented after a period of 128.83±56.76 days. Substantial time elapsed and ruled out primary brachial plexus reconstruction or nerve transfers. The average elbow flexion improved from 6.67±5.69 degrees (range: 0-20 degrees) to 86.94±12.38 degrees (range: 65-110 degrees) following unipolar latissimus dorsi transfer. 12 patients (66.67%) developed M4 or M4+ power.Conclusions: Unipolar latissimus dorsi muscle transfer is a reliable method and most of the patients develop adequate strength and satisfactory function at the elbow joint

Tissue expansion as an aesthetic alternative for facial resurfacing: a single centre series of 92 patients

Background: The visibility, vulnerability and social stigmata of facial scars whether by burn, nevi or trauma can be compelling for the patient as well as challenging for the surgeon. Restoration to normal form and aesthetics require tissue replacement which has good colour and texture match and produce minimal visible scarring.  Although many other options are available for a given defect, tissue expansion offers the best alternative which meets almost all the criteria of an ideal procedure.Methods: Among 92 patients with deformities over various facial subunits were operated and expanders 50 ml to 300 ml inserted subcutaneously adjacent to the scar. Prior planning, accurate measurement and choice of ideal expander is extremely important. A precise and practical method of calculation for determination of amount and duration of expander was used. Any secondary deformity to adjoining vital structures was avoided.Results: Results were meticulously and critically analyzed. Different shapes, dimensions and volume of expanders were used depending on the anatomical site which was to be expanded. A total of 118 expanders were inserted in 92 patients. The average volume of tissue expanders used was 170.33 ml. Majority of the expanders used had volume of 200 ml (62.71%). Post-expansion volume was 240.67 ml and the over expansion done was 41.3% over the pre-expansion volume of 170.33 ml. Surgical outcome and cosmesis was assessed by the patient’s perspective and was considered fair by 57.61% patients.Conclusions: The study underlines the clinical application, reasons for overexpansion as well as shortcomings and complications of tissue expansion

Comparison of metabolic effects of glimepride and sitagliptin with metformin in patients suffering from type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results